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PubMed1990

[Ocular toxoplasmosis and AIDS. A case report].

Ocular toxoplasmosis is uncommon in the natural course of AIDS. We report here in a case of a 27 year old man with cerebral toxoplasmosis involvement with neurological signs and coma. After an initial improvement with a sulfadiazine and pyriméthamine treatment, we noticed a foveal chorioretinitis with hyalitis in the right eye which deeply decreased the visual acuity (less than 20/400) strongly suggesting a toxoplasmic etiology. Then specific aspects such as serology, acquired or congenital toxoplasmosis, treatment are reviewed.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Intraocular anti-Toxoplasma gondii IgA antibody production in patients with ocular toxoplasmosis.

PURPOSE: To investigate the immunoglobulin classes associated with the intraocular anti-Toxoplasma gondii antibody response during clinical ocular toxoplasmosis and to determine which immunoglobulin class is most helpful in the diagnosis of this disease. METHODS: Paired serum and intraocular fluid samples from 155 patients who had uveitis were tested for intraocular anti-T. gondii IgG, IgA, and IgM antibody production. The presence of T. gondii DNA was determined by polymerase chain reaction. Patients were divided into two groups, based on the initial clinical diagnosis; group 1 included 78 patients with presumed ocular toxoplasmosis, and group 2 included 77 patients with uveitis that was not clinically suspected to be ocular toxoplasmosis. Samples from 27 nonuveitis patients who underwent intraocular surgery were used as control subjects. The final diagnosis was based on the clinical course and interpretation of laboratory tests. RESULTS: A final diagnosis of ocular toxoplasmosis was made in 88 of 155 patients (group 1, 68; group 2, 20). Among these patients, 65% had intraocular IgG production, 52% had intraocular IgA production, 37.5% had both IgG and IgA production, 27% had IgG production only, and 15% had IgA production only. Of the 13 patients tested, only one had intraocular IgM production. Intraocular IgA could not be detected in patients who had final diagnoses other than ocular toxoplasmosis or in control subjects. A positive polymerase chain reaction combined with a test that was positive for intraocular IgG production had a sensitivity of 77%, which increased to 91% after the detection of intraocular IgA production was added. CONCLUSIONS: Immunoglobulin G is the major class involved in the humoral immune response against the T. gondii parasite, followed by IgA. The determination of IgA production is useful as an additional test in the diagnosis of ocular toxoplasmosis.

Adolescent↗
PubMedDate not supplied

Clinical features and prognosis in ocular toxoplasmosis.

PURPOSE: To evaluate retrospectively the clinical characteristics, complications, and prognosis in patients with ocular toxoplasmosis. PATIENTS AND METHODS: We reviewed the records of 189 patients (243 eyes) with ocular toxoplasmosis who were examined between 1972 and 1999. Color fundus photography and, in some patients, fluorescein angiography and indocyanine green angiography were performed. There were 98 male (52%) and 91 female (48%) patients with a mean age of 22.8 +/- 8.9 years. RESULTS: Of the patients, 140 (74%) had congenital and 49 (26%) had acquired toxoplasmosis. At the initial examination, there were active lesions in 65 eyes and inactive lesions in 178 eyes. Active lesions included retinochoroiditis in 59 (91%), papillitis in 2 (3%), and neuroretinitis in 4 (6%) eyes. There was also an inactive scar in 17 eyes with active retinochoroiditis. Localisation of the active retinochoroiditis was the macula in 44 (74%), the macula and peripheral retina in 3 (5%), the peripheral retina in 9 (15%) and the peripapillary retina in 3 (5%) eyes. Optic atrophy, pigment epithelial detachment, choroidal neovascularization, lamellar macular hole, and retinal neovascularization were seen during the follow-up period. CONCLUSIONS: Ocular toxoplasmosis commonly affects the macula and seriously impairs visual acuity. The prevention of acquired and congenital infections is very important in controlling ocular toxoplasmosis. Patients should be followed to avoid late complications.

Adolescent↗
PubMed2006

Fluorescein and indocyanine green angiography in ocular toxoplasmosis.

PURPOSE: To document fluorescein and indocyanine green angiographic findings in patients with ocular toxoplasmosis. METHODS: Charts of patients with ocular toxoplasmosis who were evaluated with fluorescein and indocyanine green angiograpy were reviewed. RESULTS: In this study, eight (38%) females and 13 (62%) males with a mean age of 20.3 years were included. Of the 21 patients, five (24%) had bilateral involvement with active or inactive toxoplasmic lesion. There were active lesions in 12 (46%) eyes and inactive lesions in 14 (54%) eyes. Indocyanine green angiograpy showed hypofluorescence of the active and inactive retinochoroiditis lesions at all phases. Hypofluorescent multiple satellite dark dots were observed in 11 (92%) eyes with active retinochoroiditis and in two (14%) eyes with inactive lesions. In two patients with unilateral active toxoplasmic retinochoroiditis, hyperfluorescent plaques were observed in the fellow eyes on indocyanine green angiograpy. The fundus examination and fluorescein angiography of the fellow eyes were normal and had a visual acuity of 10/10. Choroidal neovascularization was observed in two (8%) eyes. In eyes with active inflammation, fluorescein angiography revealed early hypo-fluorescence and late intense hyper-fluorescence with fuzzy margins of the retinochoroiditis lesion (12 eyes), hyperfluorescence of the optic nerve head (four eyes) and leakage from the vessels and/or vascular sheathing (four eyes) and neuroretinitis (one eye). CONCLUSION: Toxoplasmic retinochoroiditis is a more widespread inflammation than visible fundus lesions. Indocyanine green angiography is a useful method for evaluating the amount of inflammatory activity and late complications in patients with ocular toxoplasmosis.

Adolescent↗
PubMed2003

Clinical manifestations of ocular toxoplasmosis in Yogyakarta, Indonesia: a clinical review of 173 cases.

Toxoplasmosis was the most common cause of primary retinochoroiditis. The majority of cases of ocular toxoplasmosis were congenital. However, cases of acquired ocular toxoplasmosis have been reported. The clinical manifestations of congenital ocular toxoplasmosis were choroidal coloboma, strabismus, nystagmus, ptosis, microphthalmia, cataract and enophthalmia. The purpose of this study was to determine the clinical presentation and visual outcome of 173 patients with ocular toxoplasmosis at Dr Sardjito Hospital, Dr Yap Eye Hospital, and private practice during the last six years. A total of 173 subjects were studied--98 males and 75 females. The ages at which first diagnosis was established ranged from 3 months to 68 years, frequently in young adults and occurring mostly in students. The most-reported chief complaint was blurred vision in 70.5% and floaters in 6.1% of cases. The most frequent clinical manifestations were chorioretinitis (71.2%), macular scars (22.4%), squint (6.4%), congenital cataract (2.8%), nystagmus (6.4%) and atrophic optic papilla (2.8%). Bilateral involvement was found in 32.4% of all patients. The therapeutic outcome showed improvement, especially visual acuity in acute cases (25.6%). However, visual acuity categorized as blindness was 13.9%. The results of the study imply that suddenly blurred vision in the quiet eye in the young adult, squint, and nystagmus in children could be chorioretinal inflammation and scar caused by Toxoplasma gondii.

Adolescent↗
PubMed2005

Reactivation of ocular toxoplasmosis during pregnancy.

We wished to assess whether ocular toxoplasmosis can be reactivated during pregnancy in immunocompetent females, and whether such reactivation is confined to the eye or whether the fetus is exposed to the risk of vertical transmission. For this purpose, we retrospectively examined 18 females with ocular toxoplasmosis during the course of 35 pregnancies. Of these 18 patients, seven developed recurrences during seven pregnancies. Due to the potential risk of functional damage to the mother and the possibility of vertical disease transmission to the fetus, we suggest following such cases carefully during pregnancy until the dimensions of the problem are more fully appreciated.

Female↗
PubMed2002

[Ocular toxoplasmosis antibodies in aqueous humor and serum].

BACKGROUND: The diagnosis of ocular toxoplasmosis is mainly based on ophthalmological examination but might be difficult to establish in some cases. The purpose of our study was to evaluate the value of aqueous humor and serum analysis in ocular toxoplasmosis. PATIENTS AND METHODS: We analyzed the avidity of toxoplasma-specific IgG in aqueous humor and serum samples from 50 patients with toxoplasmic retinochoroiditis, with 25 patients with uveitis posterior or panuveitis serving as controls. RESULTS: Specific intraocular antibody synthesis could be confirmed in 49 patients (98%). In two patients (8%) of the control group, antibody synthesis was detected (false positive). Forty-nine patients with diagnoses of ocular toxoplasmosis were positive for serum anti-T. gondii IgG, but only three patients had increased IgM levels. CONCLUSIONS: Analysis of local antibody production is a reliable method for confirming or excluding a suspected clinical diagnosis of toxoplasma retinochoroiditis. The determination of toxoplasma antibodies in the patients' serum is of limited value.

Adolescent↗
PubMed2006

Vitreoretinal morphology in active ocular toxoplasmosis: a prospective study by optical coherence tomography.

AIM: To investigate the third generation optical coherence tomography (OCT3) findings in patients with active ocular toxoplasmosis. METHODS: A prospective observational case series, including 15 patients with active ocular toxoplasmosis in at least one eye evaluated at a single centre. Vitreoretinal morphological features at baseline and changes within a 24-week follow-up interval on OCT3 were evaluated. RESULTS: The active ocular toxoplasmosis lesion was classified clinically as punctate (n = 6), focal (n = 6) or satellite (n = 3). Retinal layers were hyper-reflective at the active lesion site, and some degree of retinal pigment epithelium-choriocapillaris/choroidal optical shadowing was seen in all patients. In general, the retina was thinned at the active lesion site in eyes with punctate lesions and thickened in eyes with focal and satellite lesions. When detected by OCT3, the posterior hyaloid appeared thickened. While focally detached over punctate lesions, the posterior hyaloid was partially detached, but still attached to the lesion in focal and satellite lesions. Additional findings (not detected on clinical examination) include diffuse macular oedema (n = 6), vitreomacular traction (n = 3) and maculoschisis (n = 1). During follow-up, a decrease in retinal thickness and focal choriocapillaris/choroidal relative hyper-reflectivity were observed at the former lesion site, and posterior vitreous detachment progressed/occurred in all patients. CONCLUSION: OCT3 enabled identification of morphological features underestimated on clinical examination in patients with ocular toxoplasmosis, which may expand the clinical spectrum of the disease. Further studies are needed to verify the relevance of OCT3 in assisting with the diagnosis and management of ocular toxoplasmosis.

Acute Disease↗
PubMed2002

Ocular toxoplasmosis after the fifth decade.

PURPOSE: To describe the clinical features in patients presenting with ocular toxoplasmosis after the fifth decade and to analyze laboratory findings in comparison to uveitis history and clinical data. DESIGN: Prospective consecutive observational case series. METHODS: A prospective clinical analysis of 27 consecutive patients older than 50 years of age with primary or recurrent ocular toxoplasmosis was performed during a period of 8 years. These cases account for 12% of all ocular toxoplasmosis cases irrespective of age indexed in our institution during the same period. Paired serum and aqueous humor samples were tested for anti-Toxoplasma gondii IgG, IgM, and IgA antibodies. The presence of T. gondii DNA in aqueous humor was determined by polymerase chain reaction followed by DNA hydridization method. RESULTS: Although similar in age, two groups were distinguished clinically: 12 patients (44%) presented with usual forms of retinochoroiditis (mean +/- SD, 1.6 +/- 0.5 disk areas [DA] in size); 15 patients (56%) presented with atypical lesions, greater than 3 DA in size (mean +/- SD, 5.0 +/- 2.0 DA). The second group showed a higher rate of complications (P =.028) and a poorer visual outcome (P =.015). Twenty-four patients (89%) had intraocular IgG production, 17 (63%) had intraocular IgA production, 3 (11%) had intraocular IgM production, and 12 (44%) had a positive T. gondii DNA detection. CONCLUSIONS: After the fifth decade, ocular toxoplasmosis remains an important cause of posterior uveitis. The combination of antibody detection by immunocapture tests with T. gondii DNA detection, both in aqueous humor, allowed the diagnosis of toxoplasmic infection in the atypical cases with large ocular lesions.

Age Factors↗
PubMed1999

Value of estimating intraocular antibody production in diagnosis of typical and atypical lesions of ocular toxoplasmosis.

Serum and aqueous humor (AH) samples were collected from 45 patients: 20 with typically active or reactivated retinal lesions of Toxoplasma (Group I), 16 with atypical lesions (Group II) and 9 with old quiescent scars (Group III). Also, serum and AH samples were collected from 10 patients with chronic toxoplasmosis without any ocular manifestation (Group IV). T. gondii specific IgG, IgA and IgM antibodies were measured by ELISA in AH and serum and the intraocular (local) antibody production was determined by calculating Goldman-Witmer coefficient (G.W.C.). IgG antibodies were the only class detected in all sera of patients with ocular and nonocular toxoplasmosis. An intraocular IgG antibody synthesis was confirmed in 95% and 37.5% of patients with typical (Group I) and atypical (Group II) posterior uveitis respectively and in none of either patients with quiescent scars (Group III) or the ophthalmologically free patients (Group IV). As regard the typical active lesions, the sensitivity of the IgG assay (95%) was higher than that of IgA (60%) and IgM (5%) assays. Beside the conclusion that AH analysis to detect local antibody production is more reliable than the estimating of serum antibodies for the diagnosis of ocular toxoplasmosis, the detection of AH specific antibodies in 6 atypical cases, who were treated successfully by antitoxoplasmic therapy, represent a help to increase the number of uveitis cases in which specific treatment can be established.

Animals↗
PubMed2004

Fuchs' heterochromic iridocyclitis following bilateral ocular toxoplasmosis.

PURPOSE: To describe the development of Fuchs' heterochromic iridocyclitis (FHI) following bilateral ocular toxoplasmosis in an Asian Indian female. METHODS: Case report of a patient with bilateral ocular toxoplasmosis who developed bilateral Fuchs' heterochromic iridocyclitis. RESULTS: Features characteristic of bilateral Fuchs' heterochromic iridocyclitis developed following several attacks of bilateral toxoplasmic retinochoroiditis in a 26-year-old Indian female patient. CONCLUSION: Fuchs' heterochromic iridocyclitis can develop over a period of time in patients with ocular toxoplasmosis.

Adult↗
PubMed1991

Current practices in the management of ocular toxoplasmosis.

To determine current practices in the management of ocular toxoplasmosis, 72 of 85 uveitis specialists (85%) in the American Uveitis Society completed a detailed questionnaire. Questions involved the indications for beginning treatment, choice of antiparasitic/antimicrobial agents, and experience with treatment of ocular toxoplasmosis in special situations including pregnancy, neonatal infections, and immunocompromised patients. Most of the respondents treat patients whose visual acuity had decreased to worse than 20/200, lesions located in the peripapillary, perifoveal, or maculopapillary bundle regions, and lesions associated with severe vitreous inflammation. Most would not treat patients who retained visual acuity of 20/20, lesions located in the far peripheral retina, or lesions associated with only trace to mild vitreous inflammation. Treatment of other combinations of factors remains controversial. Eight different antimicrobial drugs are used in various combinations for lesions threatening the macula or optic nerve head. Systemic corticosteroids are used by 59 of 62 respondents (95%) as part of their initial treatment regimen. The most commonly used regimens are pyrimethamine/sulfadiazine/corticosteroids (20 of 62 [32%]) and pyrimethamine/sulfadiazine/clindamycin/corticosteroids (17 of 62 [27%]). Adjunctive therapies (photocoagulation, cryotherapy, or vitrectomy) have been used by 20 of 60 respondents (33%). Most alter treatment during pregnancy, in newborn patients, and in patients with the acquired immunodeficiency syndrome.

Adult↗
PubMed2001

[New trends in ocular toxoplasmosis--the review].

For past ten years some new trends can be observed in the field of ocular toxoplasmosis. In this article on the basis of reviewing scientific articles the author tried to point out important, or new information which may have an impact on clinical researches and clinical practice in the close future. 1. There is evidence that some tissue cysts can be present in untouched retinal tissue, and can produce an inflammatory reaction even many years after primary infection. This concerns both congenital and acquired toxoplasmosis. 2. The coexistence of intraocular inflammatory reaction without focal necrotizing retinochoroiditis in patients with acquired systemic toxoplasmosis was described--but there is no evidence that those inflammations were directly cause by T. gondii parasite themselves. It is too early to include this changes into the classical clinical picture of toxoplasmic retinochoroiditis. 3. For the past ten years there have been published articles showing higher prevalence of acquired ocular toxoplasmosis but this is well documented only in south America. In Europe and USA the frequency of ocular toxoplasmosis cases are low. Despite the different percentage of infected people in these populations, this controversial result can be caused by different distribution of pathogenic and non-pathogenic strains of the parasite as like by differences in human genotypes. 4. There is model of "dynamic equilibrium" existing between host defence and parasite cyst ruptures helpful for understanding reactivation. Level of tissue cyst-specific antigens does not rise in the population of HIV patients or during reactivation of ocular retinochoroiditis--this places the responsibility for reactivation on the side of host immunoresponse. 5. The most specific and reliable laboratory assessment for ocular toxoplasmosis, which is specifically helpful in clinically atypical cases, is combination of IgG, IgA and IgM serology tests made of serum and intraocular fluids. It can proof intraocular production of antibodies. PCR tests have got some value, but they are not as efficient as have been thought previously. 6. There is no efficient treatment diminishing recurrence rate and the time of singular inflammation yet. The combination of pyrimethamine, sulfadiazine and clindamycin, given for 3 to 4 weeks with supplementation of folinic acid for diminishing side effects, can diminish the measure of future scar. Long lasting treatment as it is used in children with congenital disease or in HIV patients can be probably more efficient. Atovaquone is as effective as traditional drugs and gives fewer side effects.

Animals↗
PubMed1984

Encephalitis in mice with congenital ocular toxoplasmosis.

The brains of mice with congenital ocular toxoplasmosis were examined histologically. Toxoplasma tissue cysts and a subacute/chronic meningo-encephalitis were present in the brains of all infected mice. The findings were very similar to those seen in human congenital toxoplasmosis. The murine model of congenital toxoplasmic encephalitis described in this paper will be valuable in the study of the pathogenesis, natural history and treatment of this condition.

Animals↗
PubMed1984

Retinal neovascularization and ocular toxoplasmosis.

Retinal neovascularization, a rare complication of ocular toxoplasmosis, is a source of vitreous hemorrhage. We examined three patients (all women, 70, 36, and 19 years old) with inactive toxoplasmosis scars associated with occlusion of a retinal arteriole or venule passing through the scar, capillary nonperfusion, and adjacent retinal neovascularization. In two patients photocoagulation of the ischemic areas produced a cessation of hemorrhage and the disappearance of neovascularization. In the third case, the neovascular frond was avulsed from its supplying retinal arteriole without treatment.

Adult↗
PubMed1989

Biomicroscopic evaluation and photography of ocular toxoplasmosis.

The vitreous of 39 eyes with ocular toxoplasmosis was studied and photographed using an El Bayadi-Kajiura preset lens. In active cases of toxoplasmosis, the vitreous showed inflammatory opacities and gel shrinkage. In inactive cases, the vitreous was often liquefied. Compared with 39 normal eyes of age- and sex-matched controls, the prevalence of partial posterior vitreous detachment was significantly higher in toxoplasmosis (P less than .001). A higher prevalence of posterior vitreous detachment was found in eyes with the major chorioretinal lesion outside the temporal vascular arcade than in those with lesions inside the temporal vascular arcade (P less than .05). Our results indicated that various vitreous changes may cause posterior vitreous detachment and that location of the inflammatory focus may influence the vitreous condition.

Adolescent↗
PubMed1992

Ocular toxoplasmosis in human immunodeficiency virus-infected patients.

The files of 45 human immunodeficiency virus-infected patients with ocular toxoplasmosis were reviewed, with a median follow-up of eight months. The condition was unilateral in 37 of the 45 patients (82%) and was bilateral in eight (18%). Inflammation of the anterior chamber and the vitreous was present in 32 of 53 eyes (60%) and 38 of 53 eyes (72%), respectively. Cytomegalovirus retinitis developed during the follow-up period in nine patients (20%). Cerebral toxoplasmosis was concurrently diagnosed with the ocular toxoplasmosis in 13 patients (29%). The efficacy of the combination of pyrimethamine and sulfadiazine or clindamycin was assessed in 42 patients for the induction therapy and in 38 patients for the maintenance therapy. Induction therapy was always effective within a median period of six weeks. During maintenance treatment, the 24-month relapse rates were 0.20 and 0.18 for the 50-mg/day and 25-mg/day dosage of pyrimethamine, respectively. The overall 12-month survival rate was 0.72. Our results suggested that ocular toxoplasmosis has a better ocular prognosis than cytomegalovirus retinitis, but that it requires appropriate treatment because life-threatening cerebral involvement is often associated.

Adult↗